Publications
Peer-reviewed literatures on the advances of dentistry and white papers.


Adopting iTero™ scanners to diagnose, communicate, and treat patients – a general dentist perspective.
Introduction
As a general dentist, I am always looking for solutions to make the day-to-day
activities of my practice easier for me and my staff and more enjoyable for my
established and potential new patients. I want to ensure patients have a
memorable time so that they look forward to returning and referring their family
and friends to become our patients. This may sound ironic, given the reputation
visits to the dentist have had for decades. However, dentistry has changed, and
I am proud to be one of those professionals to lead this change. Last year, I
incorporated the Align™ Oral Health Suite into my new patient exam and recall
and emergency exam workflows. The process was seamless, and the patient-friendly
product interface uses language familiar to the person sitting in your dental
chair, helps patients follow the conversation where they can actively
participate and feel part of the process during a consult. Innovations have been
developed since then, and I will describe a clinical case of how I have
implemented them into my practice, from scanning, diagnosing, designing,
treating, and monitoring

Digital dental pathways modernizing visualization, designs, and clinical outcomes: Align Technology creating comprehensive dental solutions for modern practices.
Introduction
As a general dentist, I see potential patients walk into my practice with all
sorts of oral health issues every day. Most of them are not aware of all that is
happening inside their mouths and generally come to see me for issues that are
obvious to what they see in front of a mirror or when they are in discomfort and
pain. We are traditionally trained to attend to the prospective patient’s chief
complaint, and many clinicians have a hard time communicating other important
findings. Usually, those findings stay between the clinician and assistant and
are kept on paper or your practice management software for months, even years,
without being addressed until the next emergency visit. Sometimes, the clinician
feels uncomfortable adding other procedures to the treatment plan, fearing that
he or she will be labeled as an individual trying to upsell treatment.
Unfortunately, we have seen in the media cases of dental professionals taking
advantage of people by overtreating them. While these are very few individuals,
a bad reputation has impacted the dental guild worldwide. As a professional, I
have learned to remove biases and assumptions about the person in the dental
chair. I show all the evidence and offer comprehensive treatment plans based on
the individual’s perceived needs to provide function and esthetics with
long-term solutions, not just repair. To present evidence and deliver
comprehensive education, I leverage the power of technology, specifically iTero™
scanners. These devices equip me with the tools to not only attract potential
patients to my practice but also help me to create digital records for
diagnosis, educate patients for informed decision-making,1 plan, design, treat,
and monitor their progress throughout their journey (Figure 1). This emphasis on
technology underscores the evolution of dental practice and its benefits for
both professionals and patients. I

Using iTero Element intra-oral scanner to scan for implant-supported fixed complete dentures
Abstract
Impressions in implant dentistry aim to accurately relate an analogue of the
implant or implant abutment to the other structures in the dental arch. The
impression material, impression technique, implant angulation, and the number of
implants, all affect the accuracy.
In the case of implant-supported fixed complete dentures (ISFCDs) traditional
impression techniques require the doctor to accurately capture multiple units in
one step. Doctors often encounter cases where one unit is not captured properly
while another is perfect, so they take another impression only to find that they
captured the problematic unit, but the impression of the previously perfect unit
is no longer acceptable.
Recent data suggests that intra-oral digital impressions may be considered a
reliable alternative to conventional impression materials for ISFCDs. The
ability to “segment” the impression process of large restorations and scan
different segments individually eliminates much of the uncertainty that is part
of taking a multi-unit conventional impression. It also ensures that units are
scanned at the appropriate time, when in an ideal soft tissue condition.

Reflected near-infrared light versus bite-wing radiography for the detection of proximal caries: A multicenter prospective clinical study conducted in private practices
Objectives: The aim of the present prospective multicenter clinical study was to
compare the detection of proximal caries with near-infrared light reflection
(NILR) versus bitewing radiography (BWR).
Materials and methods: Intraoral scans were performed on 100 patients in five
dental clinics using an intraoral scanner (iTero Element 5D, Align Technology,
Tempe, AZ, USA) that includes a near-infrared light source (850 nm) and sensor.
Reflected near-infrared light images of posterior teeth were used by the
individual dentists to detect proximal caries and the results were compared to
the BWRs. In a total of 3499 proximal surfaces of molars and premolars which
were examined, 223 carious lesions were detected by BWR, while NILR detected 549
carious lesions. Caries detection using both methods was also done by an expert
team of five dentists, highly experienced in NILR image interpretation, who used
the same sets of clinically-obtained data. Sensitivity, specificity, and
accuracy were calculated for caries detection by both the dentists and the
expert team. Fifty-nine of the detected carious lesions were clinically treated
and the observations during caries excavation were compared with those done with
NILR and BWR. Statistical analysis to compare between NILR and BWR diagnosis was
performed using non-parametric two-sided McNemar's Chi-Square test with the
significance level set at p < 0.05. Kappa coefficients were calculated to assess
the level of agreement between the two caries detection methods.
Results: Accuracy of NILR detection of early enamel lesions was 88% and that of
carious lesions involving the dentino-enamel junction (DEJ) was 97%. Accuracy
was found to be higher at 96% and 99%, respectively, when the same data were
examined by the expert team. Direct observation during caries-excavation
treatment suggested that NILR detected early enamel lesions that were not
detectable with BWR alone.
Conclusions: Within the limitations of the present study, NILR was more
sensitive than BWR in detecting early enamel lesions and comparable to BWR in
detecting lesions that involved the DEJ.

A fully integrated diagnostic process through advances in scanning technology
Abstract
The iTero Element 5D imaging system is the first intraoral 3D scanner integrated
with near-infrared imaging (NIRI) technology. NIRI has the potential to
revolutionize patient treatment and the overall workflow in dental offices. This
technology provides practitioners with an aid for early detection of
interproximal caries above the gingiva, which is one of the gravest threats to
oral health (equal in seriousness to periodontal disease) per the World Health
Organization (WHO).
In the near-infrared electromagnetic spectrum range of 0.7 to 2.0 μm, the iTero
Element 5D Imaging System uses light of wavelength (= 850 nm), which interacts
with the hard tissue to provide additional data of the tooth structure. The
dentin will appear bright, with areas of pathology or demineralization appearing
as white spots on the display. The iTero Element 5D imaging system, the latest
incarnation of NIRI technology, is an “innovative, integrated optical diagnostic
aid,” using a class 1 laser, as Keshav stated in the iTero Element 5D Clinical
Guide (Near-infrared imaging technology in dentistry — iTero Element 5D).
It gives practitioners the ability to view multiple dimensions of data, as well
as to virtually manipulate the model for a comprehensive view. It is the logical
next step in digital diagnostic technology and is quickly replacing both
conventional impressions and first-generation intraoral scanners. Advanced
scanning technology together with artificial intelligence (AI), streamline the
treatment and diagnosis process into the future of dentistry.

In Vitro Comparison of Three Intraoral Scanners for Implant—Supported Dental Prostheses
Abstract
With continuing technological developments, there have been advances in the
field of fixed prosthetics, particularly in impression-taking techniques. These
technological advances mean that a wide variety of diagnostic and/or
rehabilitation possibilities can be explored without the need for physical
models.
The aim of this study was to evaluate the accuracy of three intraoral scanners
used in oral implant rehabilitation using an extraoral scanner as a reference
and varying the scanning area. Three models representing different clinical
scenarios were scanned 15 times by each intraoral scanner and three times by the
extraoral scanner. The readings were analyzed and overlaid using engineering
software (Geomagic® Control X software (Artec Europe, Luxembourg)).
Statistically significant differences in accuracy were found between the three
intraoral scanners, iTero® (Align Technology Inc., San Jose, CA, USA), Medit®
(Medit®: Seoul, Korea), and Planmeca® (Planmeca®: Helsinki, Finland). In all
clinical scenarios, the iTero® scanner had the best trueness (24.4 µm), followed
by the Medit® (26.4 µm) and Planmeca® (42.1 µm). The Medit® showed the best
precision (18.00 µm) followed by the iTero® (19.20 µm) and Planmeca® (34.30 µm).
We concluded that the iTero® scanner had the highest reproducibility and
accuracy in the clinical setting.
Dent J (Basel) . 2022 Jun 15;10(6):112. doi: 10.3390/dj10060112.

Publications
Peer-reviewed literatures on the advances of dentistry and white papers.


Adopting iTero™ scanners to diagnose, communicate, and treat patients – a general dentist perspective.
Introduction
As a general dentist, I am always looking for solutions to make the day-to-day
activities of my practice easier for me and my staff and more enjoyable for my
established and potential new patients. I want to ensure patients have a
memorable time so that they look forward to returning and referring their family
and friends to become our patients. This may sound ironic, given the reputation
visits to the dentist have had for decades. However, dentistry has changed, and
I am proud to be one of those professionals to lead this change. Last year, I
incorporated the Align™ Oral Health Suite into my new patient exam and recall
and emergency exam workflows. The process was seamless, and the patient-friendly
product interface uses language familiar to the person sitting in your dental
chair, helps patients follow the conversation where they can actively
participate and feel part of the process during a consult. Innovations have been
developed since then, and I will describe a clinical case of how I have
implemented them into my practice, from scanning, diagnosing, designing,
treating, and monitoring

Digital dental pathways modernizing visualization, designs, and clinical outcomes: Align Technology creating comprehensive dental solutions for modern practices.
Introduction
As a general dentist, I see potential patients walk into my practice with all
sorts of oral health issues every day. Most of them are not aware of all that is
happening inside their mouths and generally come to see me for issues that are
obvious to what they see in front of a mirror or when they are in discomfort and
pain. We are traditionally trained to attend to the prospective patient’s chief
complaint, and many clinicians have a hard time communicating other important
findings. Usually, those findings stay between the clinician and assistant and
are kept on paper or your practice management software for months, even years,
without being addressed until the next emergency visit. Sometimes, the clinician
feels uncomfortable adding other procedures to the treatment plan, fearing that
he or she will be labeled as an individual trying to upsell treatment.
Unfortunately, we have seen in the media cases of dental professionals taking
advantage of people by overtreating them. While these are very few individuals,
a bad reputation has impacted the dental guild worldwide. As a professional, I
have learned to remove biases and assumptions about the person in the dental
chair. I show all the evidence and offer comprehensive treatment plans based on
the individual’s perceived needs to provide function and esthetics with
long-term solutions, not just repair. To present evidence and deliver
comprehensive education, I leverage the power of technology, specifically iTero™
scanners. These devices equip me with the tools to not only attract potential
patients to my practice but also help me to create digital records for
diagnosis, educate patients for informed decision-making,1 plan, design, treat,
and monitor their progress throughout their journey (Figure 1). This emphasis on
technology underscores the evolution of dental practice and its benefits for
both professionals and patients. I

Using iTero Element intra-oral scanner to scan for implant-supported fixed complete dentures
Abstract
Impressions in implant dentistry aim to accurately relate an analogue of the
implant or implant abutment to the other structures in the dental arch. The
impression material, impression technique, implant angulation, and the number of
implants, all affect the accuracy.
In the case of implant-supported fixed complete dentures (ISFCDs) traditional
impression techniques require the doctor to accurately capture multiple units in
one step. Doctors often encounter cases where one unit is not captured properly
while another is perfect, so they take another impression only to find that they
captured the problematic unit, but the impression of the previously perfect unit
is no longer acceptable.
Recent data suggests that intra-oral digital impressions may be considered a
reliable alternative to conventional impression materials for ISFCDs. The
ability to “segment” the impression process of large restorations and scan
different segments individually eliminates much of the uncertainty that is part
of taking a multi-unit conventional impression. It also ensures that units are
scanned at the appropriate time, when in an ideal soft tissue condition.

Reflected near-infrared light versus bite-wing radiography for the detection of proximal caries: A multicenter prospective clinical study conducted in private practices
Objectives: The aim of the present prospective multicenter clinical study was to
compare the detection of proximal caries with near-infrared light reflection
(NILR) versus bitewing radiography (BWR).
Materials and methods: Intraoral scans were performed on 100 patients in five
dental clinics using an intraoral scanner (iTero Element 5D, Align Technology,
Tempe, AZ, USA) that includes a near-infrared light source (850 nm) and sensor.
Reflected near-infrared light images of posterior teeth were used by the
individual dentists to detect proximal caries and the results were compared to
the BWRs. In a total of 3499 proximal surfaces of molars and premolars which
were examined, 223 carious lesions were detected by BWR, while NILR detected 549
carious lesions. Caries detection using both methods was also done by an expert
team of five dentists, highly experienced in NILR image interpretation, who used
the same sets of clinically-obtained data. Sensitivity, specificity, and
accuracy were calculated for caries detection by both the dentists and the
expert team. Fifty-nine of the detected carious lesions were clinically treated
and the observations during caries excavation were compared with those done with
NILR and BWR. Statistical analysis to compare between NILR and BWR diagnosis was
performed using non-parametric two-sided McNemar's Chi-Square test with the
significance level set at p < 0.05. Kappa coefficients were calculated to assess
the level of agreement between the two caries detection methods.
Results: Accuracy of NILR detection of early enamel lesions was 88% and that of
carious lesions involving the dentino-enamel junction (DEJ) was 97%. Accuracy
was found to be higher at 96% and 99%, respectively, when the same data were
examined by the expert team. Direct observation during caries-excavation
treatment suggested that NILR detected early enamel lesions that were not
detectable with BWR alone.
Conclusions: Within the limitations of the present study, NILR was more
sensitive than BWR in detecting early enamel lesions and comparable to BWR in
detecting lesions that involved the DEJ.

A fully integrated diagnostic process through advances in scanning technology
Abstract
The iTero Element 5D imaging system is the first intraoral 3D scanner integrated
with near-infrared imaging (NIRI) technology. NIRI has the potential to
revolutionize patient treatment and the overall workflow in dental offices. This
technology provides practitioners with an aid for early detection of
interproximal caries above the gingiva, which is one of the gravest threats to
oral health (equal in seriousness to periodontal disease) per the World Health
Organization (WHO).
In the near-infrared electromagnetic spectrum range of 0.7 to 2.0 μm, the iTero
Element 5D Imaging System uses light of wavelength (= 850 nm), which interacts
with the hard tissue to provide additional data of the tooth structure. The
dentin will appear bright, with areas of pathology or demineralization appearing
as white spots on the display. The iTero Element 5D imaging system, the latest
incarnation of NIRI technology, is an “innovative, integrated optical diagnostic
aid,” using a class 1 laser, as Keshav stated in the iTero Element 5D Clinical
Guide (Near-infrared imaging technology in dentistry — iTero Element 5D).
It gives practitioners the ability to view multiple dimensions of data, as well
as to virtually manipulate the model for a comprehensive view. It is the logical
next step in digital diagnostic technology and is quickly replacing both
conventional impressions and first-generation intraoral scanners. Advanced
scanning technology together with artificial intelligence (AI), streamline the
treatment and diagnosis process into the future of dentistry.

In Vitro Comparison of Three Intraoral Scanners for Implant—Supported Dental Prostheses
Abstract
With continuing technological developments, there have been advances in the
field of fixed prosthetics, particularly in impression-taking techniques. These
technological advances mean that a wide variety of diagnostic and/or
rehabilitation possibilities can be explored without the need for physical
models.
The aim of this study was to evaluate the accuracy of three intraoral scanners
used in oral implant rehabilitation using an extraoral scanner as a reference
and varying the scanning area. Three models representing different clinical
scenarios were scanned 15 times by each intraoral scanner and three times by the
extraoral scanner. The readings were analyzed and overlaid using engineering
software (Geomagic® Control X software (Artec Europe, Luxembourg)).
Statistically significant differences in accuracy were found between the three
intraoral scanners, iTero® (Align Technology Inc., San Jose, CA, USA), Medit®
(Medit®: Seoul, Korea), and Planmeca® (Planmeca®: Helsinki, Finland). In all
clinical scenarios, the iTero® scanner had the best trueness (24.4 µm), followed
by the Medit® (26.4 µm) and Planmeca® (42.1 µm). The Medit® showed the best
precision (18.00 µm) followed by the iTero® (19.20 µm) and Planmeca® (34.30 µm).
We concluded that the iTero® scanner had the highest reproducibility and
accuracy in the clinical setting.
Dent J (Basel) . 2022 Jun 15;10(6):112. doi: 10.3390/dj10060112.
